Is pulse palpation helpful in detecting atrial fibrillation? A systematic review

Background Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. Objective The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation. Methods We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies. Results We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%-97%) and pooled specificity was 72% (95% CI 69%-75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ratio was 0.10. Conclusions Pulse palpation has a high sensitivity but relatively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial fibrillation. It may also be a useful screen to apply opportunistically for previously undetected atrial fibrillation. Assuming a prevalence of 3% for undetected atrial fibrillation in patients older than 65 years, and given the test's sensitivity and specificity, opportunistic pulse palpation in this age group would detect an irregular pulse in 30% of screened patients, requiring further testing with ECG. Among screened patients, 0.2% would have atrial fibrillation undetected with pulse palpation.

Variability in heart rate estimates from different pulse oximeters

Since its introduction, pulse oximetry has become a conventional clinical measure. Besides being arterial blood oxygen saturation (SpO2) measure, pulse oximeters can be used for other cardiovascular measurements, like heart rate (HR) estimations, derived from its photo plethysmographic (PPG) signals. The temporal coherence of the PPG signals and thereby HR estimates are heavily dependent on its minimal phase variability. A Masimo SET Rad-9TM, Novametrix Oxypleth and a custom designed PPG system were investigated for their relative phase variation. R-R intervals from electro-cardiogram (ECG) were recorded concurrently as reference. PPG signals obtained from the 3 systems were evaluated by comparing their respective beat-to-beat (B-B) intervals with the corresponding R-R estimates during a static test. For their relative B-B comparison to the ECG, Novametrix system differed 0.680.52% (p

Radial artery pulse upstroke is not a good marker of left ventricular dysfunction: A comparison of radial tonometry, angiographic and echocardiographic measures of dP/dt

The first derivative of pressure over time (dP/dt) is a marker of left ventricular (LV) systolic function that can be assessed during cardiac catheterization and echocardiography. Radial artery dP/dt (Radial-dP/dt) has been proposed as a possible marker of LV systolic function (Nichols & O’Rourke, McDonald’s Blood Flow in Arteries) and we sought to test this hypothesis. Methods:We compared simultaneously recorded RadialdP/ dt (by high-fidelity tonometry) with LV-dP/dt (by highfidelity catheter and echocardiography parameters analogous to LV-dP/dt) in patients without aortic valve disease. In study 1, beat to beat Radial-dP/dt and LV-dP/dt were recorded at rest and during supine exercise in 12 males (aged 61±12 years) undergoing cardiac catheterization. In study 2, 2D-echocardiography and Radial-dP/dt were recorded in 59 patients (43 men; aged 64±10 years) at baseline and peak dobutamine-induced stress. Three measures at the basal septum were taken as being analogous to LV-dP/dt: (1) peak systolic strain rate, (2) strain rate (SR-dP/dt), and (3) tissue velocity during isovolumic contraction. Results: Study 1; there was a significant difference between resting LV-dP/dt (1461±383 mmHg/s) and Radial-dP/dt (1182±319 mmHg/s; P < 0.001), and a poor, but statistically significant, correlation between the variables (R2 = 0.006; P < 0.001) due to the high number of data points compared (n = 681). Similar results were observed during exercise. Study 2; there was a moderate association between baseline Radial-dP/dt and SRdP/ dt (R2 =−0.17; P < 0.01), but no significant relationship between Radial-dP/dt and all other echocardiographic measures analogous to LV-dP/dt at rest or peak stress (P > 0.05). Conclusion: The radial pressurewaveform is not a reliable marker of LV contractility.

Monitoring long distance WDM communication lines using a high-loss loopback supervisory system

In this paper, we present experimental results for monitoring long distance WDM communication links using a line monitoring system suitable for legacy optically amplified long-haul undersea systems. This monitoring system is based on setting up a simple, passive, low cost high-loss optical loopback circuit at each repeater that provides a connection between the existing anti-directional undersea fibres, and can be used to define fault location. Fault location is achieved by transmitting a short pulse supervisory signal along with the WDM data signals where a portion of the overall signal is attenuated and returned to the transmit terminal by the loopback circuit. A special receiver is used at the terminal to extract the weakly returned supervisory signal where each supervisory signal is received at different times corresponding to different optical repeaters. Therefore, the degradation in any repeater appears on its corresponding supervisory signal level. We use a recirculating loop to simulate a 4600 km fibre link, on which a high-loss loopback supervisory system is implemented. Successful monitoring is accomplished through the production of an appropriate supervisory signal at the terminal that is detected and identified in a satisfactory time period after passing through up to 45 dB attenuation in the loopback circuit. © 2012 Elsevier B.V. All rights reserved.

Synchronized mode-locked erbium fibre lasers with intracavity dispersion control using chirped in-fibre Bragg gratings

We demonstrate a dual-wavelength fibre laser system using chirped fibre Bragg gratings as reflectors and dispersive elements. The system produces two synchronized trains of soliton pulses with rms jitter of 620 fs.

Actively modelocked dual-wavelength fibre laser with ultra-low inter-pulse-stream timing jitter

We demonstrate a novel dual-wavelength erbium-fiber laser that uses a single nonlinear-optical loop mirror modulator to simultaneously modelock two cavities with chirped fiber Bragg gratings as end mirrors. We show that this configuration produces synchronized soliton pulse trains with an ultra-low RMS inter-pulse-stream timing jitter of 620 fs enabling application to multiwavelength systems at data rates in excess of 130 Gb/s.

Environmentally stable high-power soliton fiber lasers that use chirped fiber Bragg gratings

Environmentally stable high-power erbium fiber soliton lasers are constructed by Kerr or carrier-type mode locking. We obtain high-energy pulses by using relatively short fiber lengths and providing large amounts of negative dispersion with chirped fiber Bragg gratings. The pulse energies and widths generated with both types of soliton laser are found to scale with the square root of the cavity dispersion. Kerr mode locking requires pulses with an approximately three times higher nonlinear phase shift in the cavity than carrier mode locking, which leads to the generation of slightly shorter pulses with as much as seven times higher pulse energies at the mode-locking threshold.

Dispersion-modified actively mode-locked erbium fibre laser using a chirped fibre grating

The authors describe the operation of an actively modelocked Er fibre laser incorporating a chrped in fibre Bragg reflection grating as one end mirror to the cavity, acting as a lumped highly dispersive element. In one oreientation the grating shifted the cavity into normal dispersion regime and pulses of -25ps duration were produced. In the opposite oreintation, the cavity dispersion was anomalous and ~8ps pulses were produced with characterisitics typical of solitons propagating in a periodically perturbed system.

Ultrashort pulse generation from diode laser devices

This thesis presents a detailed, experiment-based study of generation of ultrashort optical pulses from diode lasers. Simple and cost-effective techniques were used to generate high power, high quality optical short pulses at various wavelength windows. The major achievements presented in the thesis is summarised as follows. High power pulses generation is one of the major topics discussed in the thesis. Although gain switching is the simplest way for ultrashort pulse generation, it proves to be quite effective to deliver high energy pulses on condition that the pumping pulses with extremely fast rising time and high enough amplitude are applied on specially designed pulse generators. In the experiment on a grating-coupled surface emitting laser (GCSEL), peak power as high as 1W was achieved even when its spectral bandwidth was controlled within 0.2nm. Another experiment shows violet picosecond pulses with peak power as high as 7W was achieved when the intensive electrical pulses were applied on optimised DC bias to pump on InGaN violet diode laser. The physical mechanism of this phenomenon, as we considered, may attributed to the self-organised quantum dots structure in the laser. Control of pulse quality, including spectral quality and temporal profile, is an important issue for high power pulse generation. The ways to control pulse quality described in the thesis are also based on simple and effective techniques. For instance, GCSEL used in our experiment has a specially designed air-grating structure for out-coupling of optical signals; hence, a tiny flat aluminium mirror was placed closed to the grating section and resulted in a wavelength tuning range over 100nm and the best side band suppression ratio of 40dB. Self-seeding, as an effective technique for spectral control of pulsed lasers, was demonstrated for the first time in a violet diode laser. In addition, control of temporal profile of the pulse is demonstrated in an overdriven DFB laser. Wavelength tuneable fibre Bragg gratings were used to tailor the huge energy tail of the high power pulse. The whole system was compact and robust. The ultimate purpose of our study is to design a new family of compact ultrafast diode lasers. Some practical ideas of laser design based on gain-switched and Q-switched devices are also provided in the end.

Pulse compression applied to the detection of F.S.K. and P.S.K. signals

The matched filter detector is well known as the optimum detector for use in communication, as well as in radar systems for signals corrupted by Additive White Gaussian Noise (A.W.G.N.). Non-coherent F.S.K. and differentially coherent P.S.K. (D.P.S.K.) detection schemes, which employ a new approach in realizing the matched filter processor, are investigated. The new approach utilizes pulse compression techniques, well known in radar systems, to facilitate the implementation of the matched filter in the form of the Pulse Compressor Matched Filter (P.C.M.F.). Both detection schemes feature a mixer- P.C.M.F. Compound as their predetector processor. The Compound is utilized to convert F.S.K. modulation into pulse position modulation, and P.S.K. modulation into pulse polarity modulation. The mechanisms of both detection schemes are studied through examining the properties of the Autocorrelation function (A.C.F.) at the output of the P.C.M.F.. The effects produced by time delay, and carrier interference on the output A.C.F. are determined. Work related to the F.S.K. detection scheme is mostly confined to verifying its validity, whereas the D.P.S.K. detection scheme has not been reported before. Consequently, an experimental system was constructed, which utilized combined hardware and software, and operated under the supervision of a microprocessor system. The experimental system was used to develop error-rate models for both detection schemes under investigation. Performances of both F. S. K. and D.P. S. K. detection schemes were established in the presence of A. W. G. N. , practical imperfections, time delay, and carrier interference. The results highlight the candidacy of both detection schemes for use in the field of digital data communication and, in particular, the D.P.S.K. detection scheme, which performed very close to optimum in a background of A.W.G.N.